General practitioners' perspectives on household energy insecurity across healthcare settings in Henan Province, China

BackgroundHousehold energy insecurity is a growing public health concern driven by rising utility costs, poor housing, and climate change, yet remains poorly understood in China. As frontline providers, general practitioners (GPs) are well-positioned to offer insights into community-level energy hardship across healthcare settings.MethodsA 2024 cross-sectional survey of 1,303 GPs in Henan Province, China, included providers from village clinics, township health centers, and county-, city-, and provincial-level hospitals. The survey assessed whether GPs had encountered patients reporting difficulty paying energy bills, utility shut-offs, home too hot/too cold, leaving their home due to unhealthy temperatures, or use of polluting fuels.ResultsOverall, 31% of GPs encountered patients struggling to pay utility bills, and 24% reported utility shut-offs. Village-level GPs had the highest prevalence (43% and 34%), while city- and provincial-level GPs had the lowest. Coal use for warmth varied by institution (p = 0.002). Compared with provincial-level GPs, township- and village-level GPs had higher odds of encountering patients with difficulty paying utility bills (aOR = 1.53, 95% CI: 1.02–2.29; aOR = 2.08, 95% CI: 1.27–3.43) and utility shut-offs (aOR = 2.10, 95% CI: 1.33–3.36; aOR = 2.47, 95% CI: 1.42–4.32); village-level GPs had non-significant odds for additional warmth (aOR = 1.23, 95% CI: 0.73–2.08).ConclusionsHousehold energy insecurity remains a major concern in China, especially in rural areas. Village GPs are uniquely positioned to identify patients facing energy hardship. Integrating screening into primary care and improving access to clean, affordable energy are keys to advancing health equity and energy justice.